Detaillierte Beitrags-Information
| Beitragstitel | Refractory autoimmune hemolytic anemia secondary to metal-on- metal total hip replacement |
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| Beitragscode | P035 |
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| Präsentationsform | Poster |
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| Abstract |
Introduction Wear of bearing surfaces and corrosion of non-moving components of total hip replacements (THR) can result in increased local and systemic metal concentrations. Metal particles may cause systemic toxicity. Secondary neurologic, cardiac, endocrine and autoimmune diseases have been described. These problems are mainly associated with large-head (≥36 mm) metal-on-metal (LH-MoM) bearing surfaces, and with wear caused by failure of taper connections. In the present report, we describe a case of refractory autoimmune hemolytic anemia (AHA) secondary to bilateral LH-MoM THR. Methods Report of the clinical features of a case. Results Bilateral LH-MoM THR had been performed elsewhere 11 years ago in a 36 years old woman because of osteoarthritis secondary to residual hip dysplasia. In the following year, she developed autoimmune hemolytic anemia. Despite treatment with high dose of glucocorticoids, splenectomy and with rituximab, AHA persisted, with persistent elevation of serum LDH and reticulocyte count, and with decreased haptoglobin levels. Following development of bilateral hematogenic periprosthetic joint infection with S. aureus, both prosthesis were explanted. Postoperatively, the hemolysis parameters rapidly normalized and the glucocorticoid treatment could be stopped, for the first time since the diagnosis of AHA. After adequate antibiotic treatment, reconstruction was performed bilaterally using uncemented cups and stems, with a ceramic-on-polyethylene bearing. At 2 years postoperatively, no recurrence of AHA nor of infection was observed. Of note, elevated chromium (3.6 µg/l) and cobalt (22.3 µg/l) serum levels had been measured years earlier, but no action had been taken. Shortly after explantation, chromium nearly normalized and cobalt levels decreased to 6.2 µg/l. Conclusion Considering the striking association between the evolution of AHA and the presence of LH-MoM THR, and healing of AHA after explantation of both prosthesis, metal immunization/intoxication must be postulated as being causative. This complication has been described only once so far. Even if AHA is a very rare complication, it is life threatening. Patient with LH-MoM THR should be monitored regularly, including determination of cobalt and chromium blood levels. References Bradberry S.M., et al Systemic toxicity related to metal hip prostheses Nakamura S et al Autoantibodies to red cells associated with metallosis- a case report, Acta Orthopaedica Scandinavica,1997 68:5, 495-496 |